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Diagnostic disagreement between clinical standard histopathological‐ and retrospective assessment of histopathology‐based gastrointestinal graft‐versus‐host disease in children
Background No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft‐Versus‐Host Disease (GI‐GVHD) Methods In a retros...
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| Published in: | Pediatric transplantation 2020-12, Vol.24 (8), p.e13824-n/a |
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| container_title | Pediatric transplantation |
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| creator | Mårtensson, Thomas Szakos, Attila Mellgren, Karin Toporski, Jacek Arvidson, Johan Mattsson, Jonas Gustafsson, Britt Casswall, Thomas H. |
| description | Background
No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft‐Versus‐Host Disease (GI‐GVHD)
Methods
In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT‐treated children ( |
| doi_str_mv | 10.1111/petr.13824 |
| format | article |
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No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft‐Versus‐Host Disease (GI‐GVHD)
Methods
In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT‐treated children (<18 years) with symptom‐based GI‐GVHD, we evaluated; disagreement of histopathology‐based GI‐GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA‐based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology‐based GI‐GVHD diagnosis by the NIH 2014.
Results
Seventy children with 92 endoscopic occasions (including 22 re‐endoscopies) were enrolled. GI‐GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI‐GVHD and 52% (22/42) with non‐GI‐GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI‐GVHD solely detected in RIHA or detection of GI‐GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re‐endoscopy was higher in endoscopic occasions with GI‐GVHD detected in RIHA but not in CSHA vs if non‐GI‐GVHD were detected in both readings (P = .005).
Conclusion
Our results suggest that in children with symptom‐based GI‐GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re‐endoscopy.</description><identifier>ISSN: 1397-3142</identifier><identifier>ISSN: 1399-3046</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.13824</identifier><identifier>PMID: 33085820</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Children ; Diagnosis ; Endoscopy ; gastrointestinal graft-versus-host disease ; Graft versus host disease ; Graft-versus-host reaction ; hematopoietic stem cell transplantation ; Histopathology ; Medical diagnosis ; Medicin och hälsovetenskap ; Stem cell transplantation</subject><ispartof>Pediatric transplantation, 2020-12, Vol.24 (8), p.e13824-n/a</ispartof><rights>2020 The Authors. published by Wiley Periodicals LLC</rights><rights>2020 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.</rights><rights>Copyright Wiley Subscription Services, Inc. Dec 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5184-646097ebdc8c62baeb42bbdbeac823f25bf291ca802c4eec9a83e111afa7611a3</citedby><cites>FETCH-LOGICAL-c5184-646097ebdc8c62baeb42bbdbeac823f25bf291ca802c4eec9a83e111afa7611a3</cites><orcidid>0000-0002-7080-5053 ; 0000-0002-4074-2653</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33085820$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-439084$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:144950245$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Mårtensson, Thomas</creatorcontrib><creatorcontrib>Szakos, Attila</creatorcontrib><creatorcontrib>Mellgren, Karin</creatorcontrib><creatorcontrib>Toporski, Jacek</creatorcontrib><creatorcontrib>Arvidson, Johan</creatorcontrib><creatorcontrib>Mattsson, Jonas</creatorcontrib><creatorcontrib>Gustafsson, Britt</creatorcontrib><creatorcontrib>Casswall, Thomas H.</creatorcontrib><title>Diagnostic disagreement between clinical standard histopathological‐ and retrospective assessment of histopathology‐based gastrointestinal graft‐versus‐host disease in children</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Background
No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft‐Versus‐Host Disease (GI‐GVHD)
Methods
In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT‐treated children (<18 years) with symptom‐based GI‐GVHD, we evaluated; disagreement of histopathology‐based GI‐GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA‐based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology‐based GI‐GVHD diagnosis by the NIH 2014.
Results
Seventy children with 92 endoscopic occasions (including 22 re‐endoscopies) were enrolled. GI‐GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI‐GVHD and 52% (22/42) with non‐GI‐GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI‐GVHD solely detected in RIHA or detection of GI‐GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re‐endoscopy was higher in endoscopic occasions with GI‐GVHD detected in RIHA but not in CSHA vs if non‐GI‐GVHD were detected in both readings (P = .005).
Conclusion
Our results suggest that in children with symptom‐based GI‐GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re‐endoscopy.</description><subject>Children</subject><subject>Diagnosis</subject><subject>Endoscopy</subject><subject>gastrointestinal graft-versus-host disease</subject><subject>Graft versus host disease</subject><subject>Graft-versus-host reaction</subject><subject>hematopoietic stem cell transplantation</subject><subject>Histopathology</subject><subject>Medical diagnosis</subject><subject>Medicin och hälsovetenskap</subject><subject>Stem cell transplantation</subject><issn>1397-3142</issn><issn>1399-3046</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp9ks9u1DAQxiMEoqVw4QGQJS4IkWInXq9zrNryR6oEQoWrZTuTrEs2DrbT1d54BB6H5-FJmGy2RSCVXDzy_L7PnyaTZU8ZPWb4vR4ghWNWyoLfyw5ZWVV5Sbm4v6uXecl4cZA9ivGKUia45A-zg7KkciELepj9PHO67X1MzpLaRd0GgDX0iRhIG4Ce2M71zuqOxKT7WoearFxMftBp5TvfTq1f338Q7JGAOXwcwCZ3DUTHCDHuvHzzt2iLCqMj1KTVETWuT4AJenylDbpJ2L6GEMeIxQqzTckAeeIwz8p1dYD-cfag0V2EJ_vzKPv85vzy9F1-8eHt-9OTi9wumOS54IJWSzC1lVYURoPhhTG1AW1lUTbFwjRFxayWtLAcwFZaloBD1Y1eCjzKoyyffeMGhtGoIbi1DlvltVP7q69YgeJiyaRAvrqTH4Kv_4huhIzzakELvkDtqzu1Z-7LifKhVeOoeFlRyRF_MePo-23ECaq1ixa6Tvfgx6gmSyEFqyiiz_9Br_wYcOATJRCklZzefzlTFv9jDNDcJmBUTaumplVTu1VD-NnecjRrqG_Rm91CgM3AxnWw_Y-V-nh--Wk2_Q1gPuuH</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Mårtensson, Thomas</creator><creator>Szakos, Attila</creator><creator>Mellgren, Karin</creator><creator>Toporski, Jacek</creator><creator>Arvidson, Johan</creator><creator>Mattsson, Jonas</creator><creator>Gustafsson, Britt</creator><creator>Casswall, Thomas H.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>ACNBI</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DF2</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-7080-5053</orcidid><orcidid>https://orcid.org/0000-0002-4074-2653</orcidid></search><sort><creationdate>202012</creationdate><title>Diagnostic disagreement between clinical standard histopathological‐ and retrospective assessment of histopathology‐based gastrointestinal graft‐versus‐host disease in children</title><author>Mårtensson, Thomas ; Szakos, Attila ; Mellgren, Karin ; Toporski, Jacek ; Arvidson, Johan ; Mattsson, Jonas ; Gustafsson, Britt ; Casswall, Thomas H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5184-646097ebdc8c62baeb42bbdbeac823f25bf291ca802c4eec9a83e111afa7611a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Children</topic><topic>Diagnosis</topic><topic>Endoscopy</topic><topic>gastrointestinal graft-versus-host disease</topic><topic>Graft versus host disease</topic><topic>Graft-versus-host reaction</topic><topic>hematopoietic stem cell transplantation</topic><topic>Histopathology</topic><topic>Medical diagnosis</topic><topic>Medicin och hälsovetenskap</topic><topic>Stem cell transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mårtensson, Thomas</creatorcontrib><creatorcontrib>Szakos, Attila</creatorcontrib><creatorcontrib>Mellgren, Karin</creatorcontrib><creatorcontrib>Toporski, Jacek</creatorcontrib><creatorcontrib>Arvidson, Johan</creatorcontrib><creatorcontrib>Mattsson, Jonas</creatorcontrib><creatorcontrib>Gustafsson, Britt</creatorcontrib><creatorcontrib>Casswall, Thomas H.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>SWEPUB Uppsala universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Uppsala universitet</collection><collection>SwePub Articles full text</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mårtensson, Thomas</au><au>Szakos, Attila</au><au>Mellgren, Karin</au><au>Toporski, Jacek</au><au>Arvidson, Johan</au><au>Mattsson, Jonas</au><au>Gustafsson, Britt</au><au>Casswall, Thomas H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic disagreement between clinical standard histopathological‐ and retrospective assessment of histopathology‐based gastrointestinal graft‐versus‐host disease in children</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2020-12</date><risdate>2020</risdate><volume>24</volume><issue>8</issue><spage>e13824</spage><epage>n/a</epage><pages>e13824-n/a</pages><issn>1397-3142</issn><issn>1399-3046</issn><eissn>1399-3046</eissn><abstract>Background
No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft‐Versus‐Host Disease (GI‐GVHD)
Methods
In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT‐treated children (<18 years) with symptom‐based GI‐GVHD, we evaluated; disagreement of histopathology‐based GI‐GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA‐based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology‐based GI‐GVHD diagnosis by the NIH 2014.
Results
Seventy children with 92 endoscopic occasions (including 22 re‐endoscopies) were enrolled. GI‐GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI‐GVHD and 52% (22/42) with non‐GI‐GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI‐GVHD solely detected in RIHA or detection of GI‐GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re‐endoscopy was higher in endoscopic occasions with GI‐GVHD detected in RIHA but not in CSHA vs if non‐GI‐GVHD were detected in both readings (P = .005).
Conclusion
Our results suggest that in children with symptom‐based GI‐GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re‐endoscopy.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33085820</pmid><doi>10.1111/petr.13824</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7080-5053</orcidid><orcidid>https://orcid.org/0000-0002-4074-2653</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley |
| subjects | Children Diagnosis Endoscopy gastrointestinal graft-versus-host disease Graft versus host disease Graft-versus-host reaction hematopoietic stem cell transplantation Histopathology Medical diagnosis Medicin och hälsovetenskap Stem cell transplantation |
| title | Diagnostic disagreement between clinical standard histopathological‐ and retrospective assessment of histopathology‐based gastrointestinal graft‐versus‐host disease in children |
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